Kayigamba, Felix R.Franke, MollyBakker, Mirjam I.Rodriguez, CarlyBagiruwigize, EmmanuelWit, Ferdinand WNMRich, MichaelSchim van der Loeff, Maarten F.2016-10-112016Kayigamba, Felix R., Molly F. Franke, Mirjam I. Bakker, Carly A. Rodriguez, Emmanuel Bagiruwigize, Ferdinand WNM Wit, Michael L. Rich, and Maarten F. Schim van der Loeff. 2016. “Discordant Treatment Responses to Combination Antiretroviral Therapy in Rwanda: A Prospective Cohort Study.” PLoS ONE 11 (7): e0159446. doi:10.1371/journal.pone.0159446. http://dx.doi.org/10.1371/journal.pone.0159446.1932-6203http://nrs.harvard.edu/urn-3:HUL.InstRepos:29002550Introduction: Some antiretroviral therapy naïve patients starting combination antiretroviral therapy (cART) experience a limited CD4 count rise despite virological suppression, or vice versa. We assessed the prevalence and determinants of discordant treatment responses in a Rwandan cohort. Methods: A discordant immunological cART response was defined as an increase of <100 CD4 cells/mm3 at 12 months compared to baseline despite virological suppression (viral load [VL] <40 copies/mL). A discordant virological cART response was defined as detectable VL at 12 months with an increase in CD4 count ≥100 cells/mm3. The prevalence of, and independent predictors for these two types of discordant responses were analysed in two cohorts nested in a 12-month prospective study of cART-naïve HIV patients treated at nine rural health facilities in two regions in Rwanda. Results: Among 382 patients with an undetectable VL at 12 months, 112 (29%) had a CD4 rise of <100 cells/mm3. Age ≥35 years and longer travel to the clinic were independent determinants of an immunological discordant response, but sex, baseline CD4 count, body mass index and WHO HIV clinical stage were not. Among 326 patients with a CD4 rise of ≥100 cells/mm3, 56 (17%) had a detectable viral load at 12 months. Male sex was associated with a virological discordant treatment response (P = 0.05), but age, baseline CD4 count, BMI, WHO HIV clinical stage, and travel time to the clinic were not. Conclusions: Discordant treatment responses were common in cART-naïve HIV patients in Rwanda. Small CD4 increases could be misinterpreted as a (virological) treatment failure and lead to unnecessary treatment changes.en-USBiology and Life SciencesImmunologyImmune ResponseMedicine and Health SciencesMicrobiologyMedical MicrobiologyMicrobial PathogensViral PathogensImmunodeficiency VirusesHIVPathology and Laboratory MedicinePathogensOrganismsVirusesBiology and life sciencesRNA virusesRetrovirusesLentivirusVirologyViral Transmission and InfectionViral LoadVaccination and ImmunizationAntiviral TherapyAntiretroviral TherapyPublic and Occupational HealthPreventive MedicineImmune SuppressionDiagnostic MedicineSigns and SymptomsPeople and PlacesGeographical LocationsAfricaRwandaMathematical and Statistical TechniquesStatistical MethodsMultivariate AnalysisBivariate AnalysisPhysical SciencesMathematicsStatistics (Mathematics)Medicine and health sciencesEpidemiologyHIV epidemiologyJournal Article2016-10-1110.1371/journal.pone.0159446